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HomeMy WebLinkAbout0097 PINEY POINT DRIVE - Health 97 PINEY POINT DR., CENTERVILLE A=228-008 i i i C'u_ _ uu 3 y No 215 COR ���s, 50 J. KAISTIN08,UN �,►Cp TOWN OF BARNSTABLE i l LOCATION /7 eey SEWAGE # VILLAGE CCJ•9 '/�/i�/�° ASSESSOR'S MAP & LOT 0Z$—t�Ok IN917ALLER'S NAME&PHONE NO. 7?/935r,9 J SEPTIC TANK CAPACITY /3700 Gs C_ LEACHING FACILITY: (type) ftd G ti wYrf�_(size) /d 4 f0 1'A-2' NO.OF BEDROOMS y ' BUILDER0:1O� AVC4,-ijev PERMTTDATE: 3—3&'91 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by gear{r Li jlb to O O ' gy O TOWN OF BARNSTABLE LOCATION Q 7 tPJMC-� ff J , SEWAGE # VILLAGE c 5NT-ERV J LL6 ASSESSOR'S MAP 6t LOT<` oATs-008 Z.al It INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY 3 r AX F ThN14,S . LEACHING FACILITY:(type) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER 90Q� BUILDER OR OWNER NH D I fit' 1401 C IA I V ;SQ Ili . OW N g-JZ DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No Z 20 i UAWN BY No.4Y r_` Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes —� PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZIpprication for Migogat *pgtem Comaruction i3ermit Application for a Permit to Construct( )Repair(i/)Upgrade( )Abandon( ) ©Complete System I Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel gr Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 7 7�- Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ei�o Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow «® gallons per day. Calculated daily flow I-)IZ/� gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank ,E� /528,67 Type of S.A.S. Description of Soil j Nature of Repairs or Alterations(Answer when applicable). Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b this Board cA Health. Signed Date Application Approved by Dates`�i Application Disapproved for the following reasons Permit No. Date Issued -r/ TOWN OF BARNSTABLE LOCATION• /Q 7 PIlley �14 SEWAGE # f J VII.LAG3>~ P rl7�'/l//��L° ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. ©10� � GQ�15�; 7,7/`9,3Q9 > SEPTLC;�TANK CAPACITY /3-00 G4L l LEACH IG.FACILITY: (type) �4 G.�L,at Ch4A1J,,L C 2 (size) Al 4-YV ICl . y NO.OF:: AROOMS �I y.. BUILD.E OI 0 la cS,�Sov 347 COMPLIANCE DATE: y 1 j Separatm Distance Between the: Maximum-,-Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private:.-.AiprSupply Well and Leaching Facility (If any wells exist on so or within 200 feet of leaching facility) Feet Edge o€;Wetland and Leaching Facility(If any wetlands exist withii:300:1'eet of leaching facility) q Feet Furnishe . v .: NX . ......... . j , �,b� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -'TOWN OF BARNSTABLE., MASSACHUSETTS 01pplication for Mi5pogal *pgtem (fongtruction j3ermit Application for a Permit to Construct( )Repair(V)Upgrade( )Abandon( ) 0 Complete System lwnm ividual Components Location Address or Lot No.�r �����o%���/ Owjneet's Name,,1Address and Tel.No. Assessor's Map/Parcel C vw U�G /1.050h Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. QD��DLp�1`1 Car�sT -7 /- Type of Building: bwelling No. of Bedrooms Lot Size sq.ft. Garbage Grinder(_'eo Other Type of Building e5' No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow yV45) gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. 7— .`S e Description of Soil e-.yl Nature of Repairs or Alterations(Answer when applicable) r'/,i`lP Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued bylthis Board 9f,Health. Signed / Date Application Approved by ,f `T Date 7� Application Disapproved for the following reasons Permit No. Date Issued �' � THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( upgraded( ) Abandoned( )by / 40 ,5 at r1C 1 ® G vo /�!/ /has been constructed in accordance with the provisions of itle 5 and the for Disposal System Construction Permit No. dated Installer Designer The issuance of this permit shall not be construed as a guarantee that`the system will function as designed. Date t-I _ G Inspector No. ee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS 1i!9pogal *p5tem Congtruction 3dermit Permission is hereby granted to Construct( Repair(✓f Upgrade( )Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be ccoompplle_ted within three years of the date of this .eijmit. ✓� Date: �j,* % J Approved b /� ���/�,G•-2�,6 �1 41 �r QcsS 'A 6 v � �o 0 f I W"7 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) 4,0��Ll*ereby certify that the application for disposal works construction permit signed by me dated v?' 27 �6 , concerning the p o� property located at T 7 �r meets all of the following criteria: /rnere are no wetlands located within :00 fee,of to proposed lesc.iing facility a,, There are no orivate weils within 1:0 ;eet of:he proposed septic system /T7 here is no increase in :low and/or=range in use.r000sed •e are no variances requested or needed. �t ne. . b/ !f the proposed leaching facility will �e locatec within ::0 tee:of inv wetlands.the oorem of:he proposed leaching -aciiiry will :ess:han :ourreen i_1-1 ;ee: above the max:mun adiustee ;roundwater tabs elevation. Please complete the following: A� J A) Top of Ground Elevation(according:o the Engineering Division G.I.S. magi `f / B)Observed Groundwater Table Elevation(according to Health Division well map) SIGNED: 71*;T DATE: 71Z LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, _ this plan should be submitted]. F beft hmw.oat No.. Fxnc....... . THE COMMONWEALTH OF MASSACHUSETTS ROAD® OF HEA TH be Appliration -for Bi_q nitti Narks. Tonstrnrtion Vrrnift Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal Syst at: - es .-------- L do -Address or Lot No. .......... yOwner ---------------------------------------•----Address Installer Address d ype of Building/ Size Lot----------------------------Sq. feet U Dwelling NO, of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) PL4 Other—Type of Building ____________________________ No. of persons.--------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures ------------------------------------------------------ ----------------------------------------------------------------------------------------------- d W Design Flow--------------------------------------------gallons per person per day. Total daily flow------------------------------------------..gallons. WSeptic Tank—Liquid capacity-------------gallons Length---------------- Width.......--------- Diameter._-.-....-----__ Depth---------------- x Disposal Trench—No..................... Width.................... Total Length-------------------- Total leaching area--------------.-----sq. ft. Seepage Pit No________________--- Diameter-_..-___--________._ Depth below inlet.................... Total leaching area------.-----------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date_---.----------------------.------------ a Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water..._____--_--._--...__.- f� Test Pit No. 2________________minutes per inch Depth of Test Pit.................... Depth to ground water--.-.--.._-----_-_-__- 9 ----------------------------------------------------------------------------------•-----------------......................................................... 0 Description of Soil----------------------------------------------------------------------------------------------------------------------------------------------------------- ------------ (ra U Nature of Repairs r Alterations—Answer when applicable...______. _.__..._ 1Q�®..__....0_C��R.7rC2__F�......_.. Agreem t: - The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has Wen issued by t board of heal igned. ------------ ------ ..... Date Application Approved By-----------f . ---- - ---•------------------ ----------------- i Application Disapproved for the following reasons:.........................................Y... -----•......•.....................Date------....... ---------------------------------------------------------------------------------------------------------.-•----------------------------------------------------------------------------------------..... Date PermitNo......................................................... Issued........................................................ Date SEW-Q.C;E-PERMIT-U-O 5.0 1- D-E-R-5-1�1- ►vl D lS,T_E-P-E-R-MI-C 1.55.U-ED _. _. :2 � �Oo�. . t �Y 6�- � .�. �__. ... �J � . .. . .: . . . .. .. � � � _. No.... Ficim....... '.................. THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEA-]TH . .: wte.•I�G OF....... ...:....G Applirtttion -fear i!i viial Porky Towitrurtion Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst at V5 L� do -Address f � l 4 or Lot No. �nXtOwne� C�fil.+t Address .... �/, -- Installer Address Type of Buildi Size Lot............................Sq. feet U Dwelling No. of Bedrooms:---------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building --.---_--.-•______________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Otherfixtures ------------•-------------------------•---••---•---- ------------••-•-----•-•---•---•-------------------•-------------------------------------------- W Design Flow--------------------------------------------gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid capacity------------gallons Length................ Width........:....... Diameter-:.------------- Depth-__-.-.--------- xDisposal Trench—No-____________________ Width-------------------- Total Length.................... Total leaching area--------------.-----sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet..........._........ Total leaching area--__-_-----.--_---sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results. Performed by----------------------_ -•-•----------------------•---•------------------- Date---------------------------------------- 0-1 Test Pit No. 1----------------minutes per inch Depth of Test Pit---;________ ------. Depth to ground water------------------------ (Z4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 ----------------------------------------------------------------------------------------------------------------•----------------------------------------- ODescription of Soil......... .............................................................................................................................................................. x -----------------------------------•--- ----------------------------------------------------------------- ---•-• . ••----. U Na ure of Repair r Alterations—Answer when applicable......__. Q�d. ''� f► .._..-... ..-....f --- - - - -- -- , .� •----•------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article NI of tlTe State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has en&issuebyA�boarr .ofheal----- - ... „. . igned Q ' '� ' Dae .•.. . Application Approved By--------- ------�--- � ---•------------------- ---------------- Date Application Disapproved for the following reasons:........................................... - -----•-------------•---•--•---------•-••---------------------- -•---••...•--•-------....-•---...-•------•-••.---••-••--------•---- .....................................----------------------------------------------------------------------------------------------- Date Permit No................... Issued........................................................ -.i ^f Date t:; s ty THE COMMONWEALTH OF MASSACHUSETTS eA t BOARD- 0P\ HEALTH *1=Lti OF..:+ ...................... ..................................................... �rrtifi #r, of falaut rlittnrr { H U CERTI Y That the Individual Sewage Disposal System constructed ( ) or Repaired (� • r at... •.• ------. + f- -• -- - --•--------•------t jo . . ....................... n i• 4 has een installed in accordance with the provisions of Article o The State Sanitary �odasldescr*b/ `� d in the application for Disposal Works Construction Permit No...__..__ .................. dated..__._.. ..._._._.__._.. ' ,THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATIlFACTORY. DATE-----------'~ --.-----'-- ------ -f--••---•--------------------- Inspector--- ---f'c�14 ^ •-'-.... 4 F L -' '�{ . / - - _ .. <" ------ ---•-•• •----••-•-..._••_... THE COMMONWEALTH OF MASSACHUSETTS BOARD . F HEAL f ......OF....... No.... -•••-- FEE... �� tt ,� �tt tr�trti�at �rr�tit r� Perm ssion is hereby granted- ----'------- -E----_ ------------- to Constr ct t)�or Rehr ( n Individual Sewage Dis sal ste at No. �/L��..- li' -------- -- -- - .�----------•----..... .ems• / - - ----------- Street • A ,' aS'shown o the application for Disposal Works Construction it N . ___._ Dated._____:..�/� -------------- t f, - - � oard o Healt� ---•-•----•- .• .... •f. 7 t - DATE ' `-------------------------------------- '' 1 FORM 1255 HOBBS '-WARREN. INC.. PUBLISHERS